Tag Archives: sleep problems in children

Snoring is noise produced during inspiration, when one is asleep, due to partial obstruction of the upper airway. It is due to the vibration of the soft palate, uvula, base of tongue and other soft tissues in the throat when one inhales. As much as 30% of the adult population or 60% of men over 40 years of age snore.

Snoring child may sound funny; but sometimes it’s a sign of a serious medical problem that should be treated. It is important to know if snoring is just normal or child has obstructive sleep apnea.

Children who snore or struggle to breathe while sleeping may suffer from Obstructive Sleep Apnea Syndrome (OSA). OSA is common in children more so in the age of 2-6 yrs when tonsils and adenoids are relatively larger.

Sleep problems and sleep apnea in children usually go unnoticed by parents. It may be the cause of poor school performance, learning disabilities, bed wetting, hyperactivity and even heart failure. Persistent open mouth, open mouth while sleeping, hypo nasal speech, nocturnal snoring, and abnormal sleep positions may be considered habitual or may escape the parents notice as patients may not be aware of significance of these symptoms.

Some common medical terminologies and definitions

Apnea means “without breath” in Greek. Sleep Apnea is described as cessation of breathing (For 10 seconds or longer) while asleep.

Hypopnea is 10 second event where breathing is continuous but ventilation is reduced by 50%.

Sleep apnea syndrome is when 30 or more episodes of apnea occur during a 7 hour sleep period.

Sum of Apnea and Hypopnea in per hour is Apnea –Hypopnea Index (AHI) and OSAS is AHI more than 5. Obstructive Sleep Apnea Syndrome by definition is excessive day time sleepiness with irregular breathing at night.

Severity of OSA is measured in terms of the number of pause of breathing per hour at night during sleep.

AHI 5-14 is mild, 15- 30 is moderate and more than 30 is severe. OSA has physical, mental and social impact on the child

Types of apnea

Obstructive Sleep Apnea – OSA is repeated episodes of airway blockage during sleep, and usually associated with snoring and reduction in blood oxygen level.

Central Sleep Apnea – Airway is not blocked but breathing centers in brain are suppressed and fail to give signals to respiratory muscles to breathe.

Mechanism of Obstructive sleep apnea

The stoppages in breathing are usually caused by the upper airway being partially or completely collapsed during sleep. During sleep upper pharyngeal airway muscles tone decrease leading to narrowing. Increase respiratory effort causes arousal from deep sleep. This circle continues several times.

Features/symptoms/consequences of sleep apnea

Child with sleep apnea will actually stop breathing for short amounts of time many times a night. After apnea event child may wake up to resume normal breathing and again goes to sleep thus sleep may be disturbed or poor quality and child may have excessive day time sleepiness (though it is more common in adults as sleep arousal threshold is higher in children).

Child may not get enough oxygen because of apneas which in long-term puts strain on heart and lungs and may cause heart attacks, heart failure, high blood pressure, strokes and sudden death while sleeping.

During the night:

Loud snoring (Cardinal symptom)

Apnea (stop breathing)

Gasping for air

Choking sensation

Restless sleep / tossing & turning in bed

Disturbed sleep/Frequent arousal

Sleeping in unusual positions (sitting position and hyper extended neck)

Waking up with a loud snore/ nightmare

Nocturia (frequent urine passing)

Enuresis (bed wetting)

Sweating

During the day:

Un refreshing sleep/ difficulty getting up in the morning

Morning headache

Dry mouth / throat

Daytime sleepiness, tiredness

Poor concentration

Poor memory

Poor school performance

Mood changes

Irritability

Paradoxical hyper activities (ADHD)

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Diagnosis of Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) must be differentiated from simple snoring. which is usually not accompanied by reduced levels of oxygen , increased co2 levels, or sleep disruption.

CPAP (Continuous Positive Airway Pressure by a nasal mask throughout the night) is the most effective and frequently used treatment for OSA.

Compliance is a major problem but family should be motivated as major surgeries can be avoided. Sleep study should be repeated every 6-12 months with upper airway growth with age.

Oral Appliances (OA)

Mouthpieces worn at night works by repositioning the tongue or mandible forward

Nasopharyngeal airway – It may be the only treatment required for some children. Like Adequate airway is developed by the age of about 3 months in Pierre Robin syndrome.

Surgery

Major complication of OSAS are reversible before the end stage heart and lung disease therefore surgery should be done for obstructive lesions of upper airway as soon as possible.

Tonsillectomy and Adenoidectomy (TAR / T&A) cures most children and it should be the initial treatment in children with other factors also.

In patients with craniofacial anomalies specific surgery can be done.

UPPP is done in selected cases.

To conclude

Sleep apnea can have serious significant complications yet vast majority remain undiagnosed and untreated because of lack of awareness by the parents and health care providers.

All children with ADHD, behavioral problems and poor academic performances should be assessed for sleep apnea by ENT specialist or pulmonologists and upper airway should be evaluated by ENT specialists for every sleep apnea child.

Disclaimer:

All material contained herein is for general information and educational purpose only and should not be considered a substitute for a consultation with a qualified health care provider. If you have any concern or question about your health please visit your physician.